Association between Signs and Symptoms of Dry Eye in Patients with and without Sjögren’s Syndrome

Mojtaba  Mohammadpour; Shahrokh  Ramin; Ali  Abbasi; Masoud  Khorrami-Nejad

doi:10.18502/jmr.v20i1.21029

Mojtaba Mohammadpour Student Research Committee, Department of Optometry, School of Rehabilitation Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Shahrokh Ramin Department of Optometry, School of Rehabilitation Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Ali Abbasi Department of Advanced Therapy Medicinal Product (ATMP), Breast Cancer Research Center, Academic Center for Education, Culture and Research (ACECR), Motamed Cancer Institute, Tehran, Iran.
Masoud Khorrami-Nejad Department of Optometry, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.

DOI: https://doi.org/10.18502/jmr.v20i1.21029

Keywords: Clinical signs; Subjective symptoms; Dry eye; Sjögren’s syndrome

Abstract

Introduction: To compare objective clinical signs and subjective symptoms of dry eye disease (DED) in patients with and without primary Sjögren’s syndrome (SS).

Materials and Methods: This study included patients diagnosed with DED due to primary SS and patients with DED without SS (non-SS DED), all meeting the inclusion criteria at Helal Hospital (Tehran, Iran). Objective clinical assessments, including tear film breakup time (TBUT), Oxford corneal staining, tear osmolarity, and Schirmer’s test I, were conducted in both groups. Subjective symptoms were assessed using the ocular surface disease index (OSDI) questionnaire. Correlation coefficients were calculated using linear regression analysis.

Results: This study was conducted from January 2023 to February 2024. Forty patients were included: 20 with SS DED and 20 with non-SS DED. The non-SS DED group had a significantly higher OSDI score (41.66±7.50) than the SS DED group (37.29±6.04; P=0.05). Tear secretion, measured by Schirmer I, was significantly higher in the non-SS DED group (P<0.01), whereas corneal staining scores were higher in the SS DED group (P<0.01). The association between OSDI scores and objective clinical test results was weak in both groups. Among SS DED patients, OSDI scores showed a moderate and significant correlation with disease duration (r=−0.529, P=0.017). Additionally, within this group, higher tear osmolarity showed a very weak correlation with lower OSDI scores (r=−0.383, P=0.096).

Conclusion: There is a weak and inconsistent association between subjective symptoms (OSDI scores) and objective clinical signs of DED in both patients with and without primary SS. Patients with SS may underreport their discomfort despite having more severe clinical signs of DED.